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New Hampshire rates for HCPCS 72133

Ct Lumbar Spine W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$89.70 / $233.85 / $233.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.90 / $342.37 / $356.54
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.09 / $57.51 / $64.19
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$167.82 / $287.81 / $299.02
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.09 / $48.15 / $110.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.76 / $413.97 / $600.25
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.58 / $123.02 / $173.97
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$136.18 / $290.95 / $417.19
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$75.81 / $75.81 / $75.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.26 / $476.64 / $875.24
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.68 / $121.88 / $177.88
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.24 / $340.23 / $741.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.81 / $394.20 / $730.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.91 / $117.14 / $217.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$155.90 / $261.24 / $513.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.58 / $360.72 / $644.12
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.49 / $79.98 / $171.75
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$175.22 / $254.07 / $556.41
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.51 / $201.86 / $256.91
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.14 / $53.34 / $58.19
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.05 / $148.52 / $162.02